Cataract Surgery

 What is a cataract? 

A cataract is a  clouding of the lens in the eye that affects vision. Most cataracts are  related to aging. Cataracts are very common in older people. By age 80,  more than half of all Americans either have a cataract or have had  cataract surgery.

A cataract can occur in either or both eyes. It cannot spread from one eye to the other.

What is the lens?  The lens is a clear  part of the eye that helps to focus light, or an image, on the retina.  The retina is the light-sensitive tissue at the back of the eye.In a normal eye, light  passes through the transparent lens to the retina. Once it reaches the  retina, light is changed into nerve signals that are sent to the brain.The lens must be clear  for the retina to receive a sharp image. If the lens is cloudy from a  cataract, the image you see will be blurred.

CLICK ON IMAGE TO LEFT TO SEE INFORMATIONAL VIDEO ON CATARACT SURGERY.

How do cataracts develop? 

Age-related cataracts develop in two ways:

1. Clumps of protein reduce the sharpness of the image reaching the retina. The lens consists  mostly of water and protein. When the protein clumps up, it clouds the  lens and reduces the light that reaches the retina. The clouding may  become severe enough to cause blurred vision. Most age-related cataracts  develop from protein clumpings.When a cataract is  small, the cloudiness affects only a small part of the lens. You may not  notice any changes in your vision. Cataracts tend to "grow" slowly, so  vision gets worse gradually. Over time, the cloudy area in the lens may  get larger, and the cataract may increase in size. Seeing may become  more difficult. Your vision may get duller or blurrier.

2. The clear lens slowly changes to a yellowish/brownish color, adding a brownish tint to vision. As the clear lens  slowly colors with age, your vision gradually may acquire a brownish  shade. At first, the amount of tinting may be small and may not cause a  vision problem. Over time, increased tinting may make it more difficult  to read and perform other routine activities. This gradual change in the  amount of tinting does not affect the sharpness of the image  transmitted to the retina.

If you have advanced  lens discoloration, you may not be able to identify blues and purples.  You may be wearing what you believe to be a pair of black socks, only to  find out from friends that you are wearing purple socks.

Who is at risk for cataract?
The risk of cataract increases as you get older. Other risk factors for cataract include:

• Certain diseases (for example, diabetes).  
• Personal behavior (smoking, alcohol use).  
• The environment (prolonged exposure to ultraviolet sunlight). 

What are the symptoms of a cataract? 

The most common symptoms of a cataract are:

• Cloudy or blurry vision.  
• Colors seem faded.  
• Glare. Headlights, lamps, or sunlight may appear too bright. A halo may appear around lights.  
• Poor night vision.  
• Double vision or multiple images in one eye. (This symptom may clear as the cataract gets larger.)  
• Frequent prescription changes in your eyeglasses or contact lenses. 

These symptoms also can  be a sign of other eye problems. If you have any of these symptoms,  check with your eye care professional.

Are there other types of cataract? 

Yes. Although most cataracts are related to aging, there are other types of cataract:

• Secondary cataract. Cataracts can form after surgery for other eye problems, such as  glaucoma. Cataracts also can develop in people who have other health  problems, such as diabetes. Cataracts are sometimes linked to steroid  use.
• Traumatic cataract. Cataracts can develop after an eye injury, sometimes years later.
• Congenital cataract. Some babies are born with cataracts or develop them in childhood, often  in both eyes. These cataracts may be so small that they do not affect  vision. If they do, the lenses may need to be removed.
• Radiation cataract. Cataracts can develop after exposure to some types of radiation.    

Cataract is detected through a comprehensive eye exam that includes:

• Visual acuity test. This eye chart test measures how well you see at various distances. 
• Dilated eye exam.  Drops are placed in your eyes to widen, or dilate, the pupils. Your eye  care professional uses a special magnifying lens to examine your retina  and optic nerve for signs of damage and other eye problems. After the  exam, your close-up vision may remain blurred for several hours.
• Tonometry. An instrument measures the pressure inside the eye. Numbing drops may be applied to your eye for this test. 

Your eye care professional also may do other tests to learn more about the structure and health of your eye.

How is a cataract treated? 

The symptoms of early  cataract may be improved with new eyeglasses, brighter lighting,  anti-glare sunglasses, or magnifying lenses. If these measures do not  help, surgery is the only effective treatment. Surgery involves removing  the cloudy lens and replacing it with an artificial lens.

A  cataract needs to be removed only when vision loss interferes with your  everyday activities, such as driving, reading, or watching TV.  You  and your eye care professional can make this decision together. Once you  understand the benefits and risks of surgery, you can make an informed  decision about whether cataract surgery is right for you. In most cases,  delaying cataract surgery will not cause long-term damage to your eye  or make the surgery more difficult. You do not have to rush into  surgery.

Sometimes a cataract  should be removed even if it does not cause problems with your vision.  For example, a cataract should be removed if it prevents examination or treatment of another eye problem, such as age-related macular  degeneration or diabetic retinopathy.If you choose surgery, your eye care professional may refer you to a specialist to remove the cataract.

If you have cataracts  in both eyes that require surgery, the surgery will be performed on each  eye at separate times, usually four to eight weeks apart.Is cataract surgery effective?  

Cataract removal is one  of the most common operations performed in the United States. It also  is one of the safest and most effective types of surgery. In about 90  percent of cases, people who have cataract surgery have better vision  afterward.

Are there different types of cataract surgery? 

There are two types of cataract surgery. Your doctor can explain the differences and help determine which is better for you:

• Phacoemulsification, or phaco.  A small incision is made on the side of the cornea, the clear,  dome-shaped surface that covers the front of the eye. Your doctor  inserts a tiny probe into the eye. This device emits ultrasound waves  that soften and break up the lens so that it can be removed by suction.  Most cataract surgery today is done by phacoemulsification, also called  "small incision cataract surgery."
• Extracapsular surgery.  Your doctor makes a longer incision on the side of the cornea and  removes the cloudy core of the lens in one piece. The rest of the lens  is removed by suction. 

After the natural lens  has been removed, it often is replaced by an artificial lens, called an  intraocular lens (IOL). An IOL is a clear, plastic lens that requires no  care and becomes a permanent part of your eye. Light is focused clearly  by the IOL onto the retina, improving your vision. You will not feel or  see the new lens.
Some people cannot have  an IOL. They may have another eye disease or have problems during  surgery. For these patients, a soft contact lens, or glasses that  provide high magnification, may be suggested.

What are the risks of cataract surgery?
As with any surgery,  cataract surgery poses risks, such as infection and bleeding. Before  cataract surgery, your doctor may ask you to temporarily stop taking  certain medications that increase the risk of bleeding during surgery.  After surgery, you must keep your eye clean, wash your hands before  touching your eye, and use the prescribed medications to help minimize  the risk of infection. Serious infection can result in loss of vision.

Cataract surgery  slightly increases your risk of retinal detachment. Other eye disorders,  such as high myopia (nearsightedness), can further increase your risk  of retinal detachment after cataract surgery. One sign of a retinal  detachment is a sudden increase in flashes or floaters. Floaters are  little "cobwebs" or specks that seem to float about in your field of  vision. If you notice a sudden increase in floaters or flashes, see an  eye care professional immediately. 

A retinal detachment is a medical emergency. If necessary, go to an emergency service or hospital. Your eye must be examined by an eye surgeon as soon as possible. 

A retinal detachment causes no pain. Early treatment for retinal detachment often can prevent permanent loss  of vision. The longer the retina stays detached, the less likely you  will regain good vision once you are treated. Even if you are treated  promptly, some vision may be lost.Talk to your eye care professional about these risks. Make sure cataract surgery is right for you.What if I have other eye conditions and need cataract surgery?  

Many people who need  cataract surgery also have other eye conditions, such as age-related  macular degeneration or glaucoma. If you have other eye conditions in  addition to cataract, talk with your doctor. Learn about the risks,  benefits, alternatives, and expected results of cataract surgery.

What happens before surgery?  

A week or two before  surgery, your doctor will do some tests. These tests may include  measuring the curve of the cornea and the size and shape of your eye.  This information helps your doctor choose the right type of IOL.You may be asked not to eat or drink anything 12 hours before your surgery.

What happens during surgery?  

At the hospital or eye  clinic, drops will be put into your eye to dilate the pupil. The area  around your eye will be washed and cleansed.

The operation usually  lasts less than one hour and is almost painless. Many people choose to  stay awake during surgery. Others may need to be put to sleep for a  short time. If you are awake, you will have an anesthetic to numb the  nerves in and around your eye.

After the operation, a  patch may be placed over your eye. You will rest for a while. Your  medical team will watch for any problems, such as bleeding. Most people  who have cataract surgery can go home the same day. You will need  someone to drive you home.

What happens after surgery? 

Itching and mild  discomfort are normal after cataract surgery. Some fluid discharge is  also common. Your eye may be sensitive to light and touch. If you have  discomfort, your doctor can suggest treatment. After one or two days,  moderate discomfort should disappear.

For a few days after  surgery, your doctor may ask you to use eyedrops to help healing and  decrease the risk of infection. Ask your doctor about how to use your  eyedrops, how often to use them, and what effects they can have. You  will need to wear an eye shield or eyeglasses to help protect your eye.  Avoid rubbing or pressing on your eye.

When you are home, try  not to bend from the waist to pick up objects on the floor. Do not lift  any heavy objects. You can walk, climb stairs, and do light household  chores.In most cases, healing will be complete within eight weeks. Your doctor will schedule exams to check on your progress.

Can problems develop after surgery?

Problems after surgery  are rare, but they can occur. These problems can include infection,  bleeding, inflammation (pain, redness, swelling), loss of vision, double  vision, and high or low eye pressure. With prompt medical attention,  these problems usually can be treated successfully. Sometimes the eye tissue that encloses the IOL becomes cloudy and may blur your vision. This condition is called an after-cataract. An after-cataract can develop months or years after cataract surgery.

An after-cataract is  treated with a laser. Your doctor uses a laser to make a tiny hole in  the eye tissue behind the lens to let light pass through. This  outpatient procedure is called a YAG laser capsulotomy. It is  painless and rarely results in increased eye pressure or other eye  problems. As a precaution, your doctor may give you eyedrops to lower  your eye pressure before or after the procedure.

When will my vision be normal again? 

You can return quickly  to many everyday activities, but your vision may be blurry. The healing  eye needs time to adjust so that it can focus properly with the other  eye, especially if the other eye has a cataract. Ask your doctor when  you can resume driving.

If you received an IOL,  you may notice that colors are very bright. The IOL is clear, unlike  your natural lens that may have had a yellowish/brownish tint. Within a  few months after receiving an IOL, you will become used to improved  color vision. Also, when your eye heals, you may need new glasses or  contact lenses.

What can I do if I already have lost some vision from cataract? If you have lost some  sight from cataract or cataract surgery, ask your eye care professional  about low vision services and devices that may help you make the most of  your remaining vision. Ask for a referral to a specialist in low  vision. Many community organizations and agencies offer information  about low vision counseling, training, and other special services for  people with visual impairments. A nearby school of medicine or optometry  may provide low vision services.

What research is being done? 

The National Eye  Institute is conducting and supporting a number of studies focusing on  factors associated with the development of age-related cataract. These  studies include:

• The effect of sunlight exposure, which may be associated with an increased risk of cataract.  
• Vitamin supplements, which have shown varying results in delaying the progression of cataract.  
• Genetic studies, which show promise for better understanding cataract development. 

What can I do to protect my vision? Wearing sunglasses and a  hat with a brim to block ultraviolet sunlight may help to delay  cataract. If you smoke, stop. Researchers also believe good nutrition  can help reduce the risk of age-related cataract. They recommend eating  green leafy vegetables, fruit, and other foods with antioxidants.

If you are age 60 or  older, you should have a comprehensive dilated eye exam at least once  every two years. In addition to cataract, your eye care professional can  check for signs of age-related macular degeneration, glaucoma, and  other vision disorders. Early treatment for many eye diseases may save  your sight.

What should I ask my eye care professional? 

You can protect  yourself against vision loss by working in partnership with your eye  care professional. Ask questions and get the information you need to  take care of yourself and your family.

What are some questions to ask?

About my eye disease or disorder...

• What is my diagnosis?  
• What caused my condition?  
• Can my condition be treated?  
• How will this condition affect my vision now and in the future?  
• Should I watch for any particular symptoms and notify you if they occur?  
• Should I make any lifestyle changes? 

About my treatment...

• What is the treatment for my condition?  
• When will the treatment start and how long will it last?  
• What are the benefits of this treatment and how successful is it?  
• What are the risks and side effects associated with this treatment?  
• Are there foods, drugs, or activities I should avoid while I'm on this treatment?  
• If my treatment includes taking medicine, what should I do if I miss a dose?  
• Are other treatments available? 

About my tests...

• What kinds of tests will I have?  
• What can I expect to find out from these tests?  
• When will I know the results?  
• Do I have to do anything special to prepare for any of the tests?  
• Do these tests have any side effects or risks?  
• Will I need more tests later? 

Other suggestions

• If you don't understand your eye care professional's responses, ask questions until you do understand.  
• Take  notes or get a friend or family member to take notes for you. Or, bring a  tape recorder to help you remember the discussion.  
• Ask your eye care professional to write down his or her instructions to you.  
• Ask your eye care professional for printed material about your condition.  
• If you still have trouble understanding your eye care professional's answers, ask where you can go for more information.  
• Other members of your health care team, such as nurses and pharmacists, can be good sources of information. Talk to them, too. 

Today, patients take an active role in their health care. Be an active patient about your eye care.Where can I get more information?      

For more information about cataract, you may wish to contact:National Eye Institute (NEI)31 Center Drive MSC 2510 Bethesda, MD 20892-2510 (301) 496-5248 http://www.nei.nih.govConducts  and supports research on eye diseases and vision disorders. Offers free  publications for the general public and patients.  National Marfan Foundation22 Manhasset Avenue Port Washington, NY 11050 1-800-862-7326 (516) 883-8712 http://www.marfan.orgDisseminates  information about Marfan syndrome, a genetic disorder of the connective  tissues in which dislocated lenses, cataract, and retinal detachment  are ocular symptoms. Provides a communication network for patients and  their family members. Supports and encourages research. Publishes The Marfan Syndrome, a comprehensive booklet on the disease, and A Guide for Eye Care Professionals.

For more information about IOLs, contact:American Society of OcularistsP.O. Box 7342 Charlottesville, VA 22906-7342 1-866-973-4066 (434) 973-4066 http://www.ocularist.org/American  Society of Ocularists is an international, non-profit, professional and  educational organization founded by technicians specializing in the  fabricating and fitting of custom-made ocular prosthetics (artificial  eyes). Offers referrals to local ocularists.
U.S. Food and Drug Administration Office of Consumer Affairs Parklawn Building (HFE-88) 5600 Fishers Lane Rockville, MD 20857 1-888-463-6332 www.fda.gov

For more information about low vision services and programs, you may wish to contact:American Academy of Ophthalmology P.O. Box 7424 San Francisco, CA 94120-7424 (415) 561-8500 http://www.aao.orgRepresents  board-certified ophthalmologists in the United States. Offers public  information materials and clinical education programs in a variety of  formats. Offers a Find a Doctor service on their website to help people  locate local board-certified ophthalmologists.

American Foundation for the Blind11 Penn Plaza, Suite 300 New York, NY 10001-2006 1-800-232-5463 (212) 502-7600 afbinfo@afb.net http://www.afb.orgServes  as a one-stop information and referral resource for people who are  blind or visually impaired, the people who work with them, and the  general public. Conducts a wide variety of programs to support  independent living, literacy, employment, and access to technology.  Publishes professional materials for blindness and low vision and  Talking Books. Offers consultation services to eye care, rehabilitation,  and education professionals. Provides referrals to low vision centers.  Advocates for legislative change.

Council of Citizens with Low Vision International1-800-733-2258 Serves  as an advocacy group for the visually impaired. Provides information on  low vision technology. Offers scholarship. Publishes the CCLV News.

Lighthouse International111 East 59th Street New York, NY 10022-1202 1-800-334-5497 1-800-829-0500 (212) 821-9200 (212) 821-9713 (TDD) info@lighthouse.org http://www.lighthouse.orgServes  as a national clearinghouse for information on vision impairment across  the life span including specific services for children and seniors.  Offers a comprehensive selection of educational products, large print  materials, talking products, and related specialty items for people with  visual impairments. Offers reading and library services, employment and  recreation resources, and technology centers.

National Association for Visually Handicapped22 W. 21st Street, 6th Floor New York, NY 10010-6493 (212) 889-3141 http://www.navh.org. Serves as a clearinghouse for information about all services available to the  partially-sighted from public and private sources. Conducts self-help  groups. Provides information on large print books, textbooks, and  educational tools.